Levosert (Levonorgestrel)

Levosert is a hormonal intrauterine system that acts on the reproductive tract to prevent pregnancy and treat menstrual disorders.

• Contraception (prevention of pregnancy): offers up to five years of highly effective reversible birth control.
• Heavy menstrual bleeding: reduces menstrual blood loss and improves cycle regularity.
• Endometrial protection: suppresses endometrial proliferation, helping to manage hormone‑related uterine conditions.

• Levosert releases levonorgestrel locally within the uterine cavity at approximately 20 µg per day. The progestin thickens cervical mucus, impairs sperm motility and viability, and suppresses endometrial growth. In many users it also inhibits ovulation, creating a multi‑layered barrier that prevents fertilisation and implantation.

Levosert may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Irregular vaginal bleeding or spotting.
• Amenorrhea (absence of periods) after initial months.
• Pelvic or uterine cramping.
• Breast tenderness or enlargement.
• Ovarian cyst formation.
• Headache or mild nausea.

Serious or Rare Side Effects

• Uterine perforation during insertion.
• Device expulsion or displacement.
• Pelvic inflammatory disease or severe infection.
• Ectopic pregnancy if contraception fails.
• Allergic reaction to device materials.
• Severe abdominal pain requiring medical evaluation.

Before insertion and during use, certain precautions should be observed to ensure safety and effectiveness.

• Pregnancy testing: confirm the patient is not pregnant prior to insertion.
• Uterine abnormalities: evaluate for fibroids, congenital anomalies, or scarring that may affect placement.
• Active infection: defer insertion if pelvic infection or sexually transmitted disease is present.
• Bleeding disorders: assess coagulation status and advise on potential increased bleeding.
• Hormone‑sensitive conditions: avoid use in known breast cancer or severe liver disease.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Levosert has limited systemic exposure, but certain drugs can affect levonorgestrel levels.

Major Interactions (Avoid)

• Rifampicin and other strong CYP3A4 inducers: may markedly reduce contraceptive efficacy.
• St. John's wort (hypericum perforatum): can lower levonorgestrel concentrations.

Moderate Interactions (Monitor Closely)

• Antiretroviral protease inhibitors (e.g., ritonavir): may alter hormone metabolism.
• Certain anticonvulsants (e.g., carbamazepine, phenytoin): may modestly decrease effectiveness.
• Antifungal agents (e.g., ketoconazole): could increase levonorgestrel exposure, requiring monitoring.